MEDICARE: COUNTY OF RICHLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093902140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF RICHLAND

Provider Business Mailing Address
First Line	:	314 CLEVELAND AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44902-8623
Country	:	US
Telephone Number	:	419-774-4200
Fax Number	:	419-774-4207

Provider Business Practice Location Address
First Line	:	860 WOODVILLE RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2167
Country	:	US
Telephone Number	:	419-522-4368
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MS. ELIZABETH G PRATHER
Credential	:
Telephone Number	:	419-774-4200

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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Directions to “COUNTY OF RICHLAND ” Practice Location

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